every century into thepresent, en ireland holds for the seventh time the rotation presidency of the council administered in our 40th year of the membership of the union. be it in our ancient cultic connections and our continuous connection with european scholarships, or in our constant support for the european unity, we are european in our consciousness and commitment. europe has always had an existence in the irish mind. in our own language the stories of europe have always been present. and some recall that made of the classical sources of the schools that preceded the widespread english-language. the irish language that preceded

english had been deeply influenced by ancient european men. particularly the great such as [inaudible] in the areas across the people of europe have had a a sense of respect for what is a cultural diversity frequently drawn from the shared sense. it was however in the task of the mind and in the spirit that the irish sought to make the greatest contribution. ..

and it is to the spirit of citizenship that ended my knee at a european level that might motivate you as one who gives to the true words european enya and, a sense of fulfillment and human flourishing i wish to speak in this year that has been dedicated. one more word about that meeting in july 1950. nomar did some meetings of the contemporary. come israel agenda was not a public indication. it is declared to be -- about

that meeting in july 19 tsa state some meetings of the contemporary period at which i will not speak come israel agenda was not as publicly advocated. in france at the time later to meet pope john xxiii as does the bishop who we know from the work of the distinguished scholar, modernist linguists at the meeting was really organized to first facilitate a meeting of robert schumer, foreign minister of france with like-minded others or may not break european countries, anxious to hear and test his great idea for the coming together of the countries of europe. shoot man who was aware of

affairs recalled the early monastic act and offer the opinion to be the patrons think about those who now seek t build a united europe. and the others which followed it assisted such as john monet was responding to near and terrible event that we should never forget and i emphasize today that in their response at that meeting, they recognize the rich scholarship of philosophy, moral instincts of european total not just to replace where we ease, but more importantly to construct a vision of europe's people working together in an inclusive way. and was not just an abstract

construction. it is a practical proposal drawn for the head of memory and experience, prepared by the heart and its united economy and at six in exasperation for a common shared unit. with the inspiration in the achievement of the founders of the european union, we inherited the legacy. today citizens in europe are threatened with that conscious draft to disarm any. a social cohesion, recurrence of racism and increasing democratic accountability in some decision-making of an economic and fiscal kind. these threatening clouds hang over europe in a most hopeful time chosen to base rather than anything contemporary as of 02

joyous musical ludwick beethoven in 970. parliaments matter. parliament must continue to matter. centuries have been invested by european citizen in securing the vote, for example, extending the vote. it is to parliament citizens look for accountability for strategic alternatives. the european front to lose the of accountability, where else might be found? is there an alternate effect can the requirements of a deliberative democracy? i believe not, but i believe parliament and the straw on resources the next variants of inherited intellectual capacity

and above all from the best of contemporary intellectual work and must do so and it curless way. i am conscious in this year at european citizen but as parliamentarians, you are the elect a component of the european union, elected by citizens from diverse electorates within the same few days and i want to wish you well and in all your deliberations together and with other institutions of the union and particularly in your dialog with your electorate, the citizens of europe. the citizens placed their trust in parliament monday votes and they have expectations of parliament responding to their needs. i very much welcome the increasing influence of the decision-making power the european parliament for the multiannual budgeting process.

as a power that parliament did not have when i visited here as minister and president in 1996. and i wish you well in discharging the responsibility on behalf of the citizens of europe. but how would the founders of the european union respond to our present circumstances. we know how institutions work to overcome the most serious economic crisis the union has stay since its foundation. how they struggle the ferocity of its onslaught they're not accountable at all. we cannot nor the fact european citizens are suffering the consequences of inaction of parties such as rating agencies, which unlike parliament are

simply unaccountable. many citizens in europe in response to the crisis in my life adesperate, sometimes delayed at the urgency of the time of showing and often not shown sufficient threatened circumstances of today. they see in general terms to economic narrative every say either has been imprisoned by drive type haakon found. for example, calculations that are abstract and not drawn from real problems such as unemployment. primarily by consideration of the impact of such measure on speculative matter rather than sufficient compassion and entity with european citizens and from

all of those capacity, political, social economic and intellectual might have been drawn upon if it had been by the binding moral spirit of the union. in facing up to the challenge europe currently faces, particularly in relation to unemployment, we cannot afford to place our single soul in a single hegemonic model to the exclusion of the other model that might engage best problems such as unemployment by critically accepting solely and exclusively a burst of logistic economic assumptions are narrow and intellectually questionable and largely indifferent to social consequences in terms of there.

rather than any to find european union is simply an economic space between the strong and the weak. our citizens yearn for the language of solidarity, commitment to cohesion for an inclusive rhetoric that is appropriate to an evolving political union anxious to reach a future of peace, prosperity come inclusion, intergenerational justice in a sustainable way and this is a serious challenge not least because if we were to fail to run the risk of an economic crisis leading to a crisis of legitimacy for the union that after all and its founding treaty is eventually found us on values such as respect for personal dignity, freedom, democracy, quality, rule of law and respect for human rights.

the union address legitimacy in the supportive citizen that connection as a citizen of the least the european union we are a drift of citizens an appeal to the heart as well as farewell. they need reassurances now that this european will keep faith with the founding treaty. it has been many years since europe is the soil, but it remains just as true. we must not forget that we are the inheritors of a profoundly set of european values. great democracy, roman law, christian tradition, the reformation, enlightenment, great democratic resolution that began in france. europe is more than an economic space of confiscation in which

our citizens are invited are required to deliver up their lives of an abstract model of economy and society whose core assumptions this is not to question our democratic test an election. as we stay into the future, when he too draws strength from those founding values of the union, values that include cohesion and solidarity among member states, among citizens of our union and between the european union and the rest of the world. we need to work together to apply ourselves to building a better future together. europe does not just the firefighters. it makes architects, too. and the terrorists must be to get europe back to sustainable employment and a return to real

growth. there is nothing more corrosive to society and more crushing to the person and endemic unemployment, particularly among the young. with 26 million people across the union without work, 115 million people in our union at risk of poverty and social exclusion. we simply cannot allow this to continue. and they've always strong practically from the spirit of the founding treaty and the current irish presidency has therefore put job creation at the top of its agenda in the european council has agreed addressing unemployment is the most important social challenge we face. at last been social summit, mr. president commemorate the warrant of the repercussion of the spread of unemployment and poverty across the union peers

so therefore i command the agreement reached at the european council in february on the youth employment initiatives and proposals from the commission to make it operational by the start of next year. the matter is urgent and i also very much welcome the youth guarantee that will ensure i got people under the age 25-acre quality employment education, apprenticeship or trading with the informants have been unemployed. we need to ensure women participate in the workplace is equal, that older workers are not up to the sideline and the long-term unemployed are fully equipped to find their way back in two days for day and we must most of all ensure for european citizens that loss of employment does not lead to exclusion from participation, particularly the culture of space and community. we need to continue how to encourage people to create jobs

in value and support small and business enterprise and allowed out of so many communities. we need to sustain those who want to create opportunity for those in others. we need creativity, innovation, entrepreneurship. it is of course not one that looks solely on word. the european model has inspired many others on their journey to peace and democratic institutions and while it might be not have doubled so greatly in recent year, europe can be of economic hope and encouragement from many less fortunate people in the world. it can give you the race began with the unified folks on climate change, recognizing those is contributing to our global problem are paying the highest price, even as they speak about me today. europe already is of course the largest number in the fight

against hunger and the efforts of ceiling of nutritionand that isomhican build on. so how does the european union engage with the rest of the world is a major test of authority and credibility. what a difficult is to undermine commitment on the global challenges of our day. hunger, poverty, i hope not. the generous idealism of european vision in solidarity with other partners. i hope we do. granted measures that replace the development goals, holiday respect diversity can i recognize different parser development, have human rights would be a major test voted for the global community. it has the courage to face his

past, including darker periods of empire and its future with the commitment to values that are inclusive of all humanity with the discourse of respect diversity has a profound contribution to make not only to its own citizens in europe, but to the global community. it can give an increasing form of ethical globalization such an integrated discord is missing just now. the narrative seems to be attracted intellectually. they are intellectually and a structure they are unable to challenge for which it stands

they are going to escape the exit. in the absence that are considering, however, other possible models are approaching. we are in danger now of drifting into my sustaining a kind of moral and we have available i repeat again advocacy of intellectual radical work upon which to draw from the past and in the contemporary world. they are in our shared intellectual heritage upon which so much we could draw and let us remember in the pursuit of new thought that for examples european enlightenment from the part about there there are some powerful examples. let us never forget that's the singular example given by those dissident speakers and nighttime

nighttime -- day they and their times are identified the enlightenment thinking that supported its insatiable drive and they courageously challenged in their books, pamphlets and public exception. the logical strand of economics, which today stands as a single hegemonic model of economic theory, not a finger up is the flaw of our time. the classic economics -- [applause] is stranded neoclassic economics is of course useful for unlimited and defined time. it is insufficient, however, as an approach for problems in future. we need to substantiate moral and political economic models and an emancipatory discourse to deliver them and i think just this is possible.

because the dominated model of this method defines not only discourse, the policy options. there is a need now for new models of connection between economy, society and policy. they are essential for genuine pluralist racism policy and the speech of democratic accountability and relevant sewer problem. if we are to address the current challenges as european parliamentarians, i encourage you to let these new models into the european discourse, give them space in the committee structure of your parliament and the institutional structure of the union. to achieve that discourse, of public intellectuals is also and urgent one. they are unequivocally the problem of europe are not simply

technical and certainly not solely amenable to solutions by technocratic measures at the expense of democratic accountability. clap back the suggestion that citizens and representatives are not fiscally or economically literate enough to carry decision-making necessary for policies that impinge on their lives been unemployment housing health education or the environment has been a serious implications in legitimacy charms. it is an assumption that challenges democracy itself. a version of economic space is used as a substitute for people and societies that state. this in its connection with history and content challenges and? the moral connection with the ethics and solidarity we now need. it would evade rather than face

the present challenge. european union is to be respect good is a great progress citizen can be ascribed intellectual heritage and imaginings and existing talent and capacity of the people of europe. if our european union and prospects that must be made so enter reasserting the idealism, the intellectual strength in the world courage picture of the founding fathers of the union. they are for people zip history with possibilities as we are an alternative is simply to regard our people as dependent area

boasts to the rating agency. agencies unaccountable and indeed found on so many occasions. consider these citizens, we would be recused to the status of mere consumer and a speculative chessboard. [applause] and derived from assumption that are weakened in a scholarly sense, untestable and empirical sense and very frequently undeclared. so our decisions be normative rather than be narrowly fiscally tight craddick is i suggest more than an integration of her intellectual capacity to defend in defend democracy. i have readily acknowledged that want to be clear i believe very

much in the utility in so many areas. however, its methods are elevated to being substituted for the integrated disciplinary scholarship would now need to address the very context and contingencies of current challenges, such as silver lion on a technocratic approach up remarkably insufficient. if we are to deliver the european union at the sent prosperity that the founders that visit and i believe the citizens of europe during four beyond the understandable fear of present circumstances. scholarship and world views about the social science is an ethics and philosophy is required to present numbers of parliament, commissioners, from the flex of diverse from our

current problem, from fears and aspirations, are hopeful that marriage and of islam that constitutes the tapestry of many color of different strains and threats in its design evocative of what member has endured and the human spirit has invested without. whether it is made out of one reason or vote with a prayer will not matter in the end be about matters is the work of the slow working together in cooperation of cosmopolitan up into the world, caring for it and intergenerational a responsible way and embracing our people as equal citizens. so let us citizens who want to make a real union together move out of the dark into the light

and achieve something indeed worthy originally called to freedom go to it. [applause] [applause] made salad >> translator: thank you very much indeed, president higgins, for your wonderful speech.

i don't know, presidents, whether every member of the house agrees with every tiny detail of what you said. i doubt that they did, but i listen to enthusiasm perhaps not everybody equally enthusiastic in this chamber. one thing i can assure you a, ireland is a lucky country to have such a wonderful head of state. you've given us encouragement. thank you. [applause]

>> necks, hearing on privacy lesson mental health. lawmakers are testimony from the health sector and families affect did known as hippa or health information portability and accountability act. [inaudible conversations] >> good morning. be here today the oversight investigations subcommittee for a hearing entitled to train to help or hinder key. as there is a classified reefing

as well as both this morning, with opening statements in order to get to the witness testimony. we will allow members to submit the ripping testimony for the record. at a hearing last month issues raised after the newtown tragedy they told how hippa hindered their ability to help loved ones. they're here from professionals, parents, experts, family or his. i ask all members the reason we are here is members of congress are experts on these issues and we appreciate your attention to this. we are here to ask questions of our facts about hippa for those knowledgeable and remind everyone we need to maintain decorum. disruptions would not be tolerated in people doing so will be discharged if needed. we also are asking members to stick closely to the time limit. >> what the chairman you

earthly? the chairman and i've agreed to put the opening statements in the record and i think that's appropriate given us a classified scheduled yesterday. out of respect to witnesses around the country, the chairman i decided we wanted to hear from the witnesses. i will say, mr. chairman, that this is an important topic, as they relate to gun violence. it's also important ever been asked to get u.s. militarily or otherwise involved in syria in this briefing that the secretary of state. on behalf of everybody, i want to apologize to the witnesses. some of us may be in and out. but we didn't testimony in nova scotia not. thank you very much. >> i want to let members know i communicated with majority leader eric cantor last evening

and he is providing a special briefing for any members to remain through this committee. you are worried that committee is holding a hearing. when doing so we have taken testimony under oath. the chair advises you under the post of the house and committee are entitled to be advised the council. to advised to be counseled testimony today? please rise and raise your right hand and elsewhere even. douceur the testimony are about to give us the truth, whole truth and nothing but the truth? the record show the witness is answered in the affirmative. you're subject to penalties set forth in section 1001 of the united states code. you may not give a five-minute opening statement. i'm introduced the witnesses for today's hearing. the first panel is mr. leon rodriguez at the office for

civil rights at department of health and human services. he oversees the operations of the solar rate division. mark rothstein at the university of louisville school of law in school of medicine. he holds a herbert f. ball chair of law and is the founding director of the institute for bioethics help policy at the university of louisville school of medicine. you may begin. make sure your microphone is on. thank you. >> you may begin. good morning, mr. chairman, ranking member degette and the subcommittee. it's a matter to be here as the director for civil rights for health and human services and a thank you for calling a hearing on this important topic. as the health privacy rights, ocr handles policy development and education for compliance in those areas.

practice is an important role in ensuring health information remains private and secure and individuals are able to exercise and port rights with respect to health information. one of the underpinnings of hippa is optimal health care depends for many patients on their trust that their health information remains confidential hippa ensures health information can flow from necessary purposes such as patient treatment for health services and protect the country's public health and safety. i've often said hippa is meant to be a valid not a blockage and is above all meant to maximize the welfare ventures to the patient. such a look forward to discussing the existing flexibilities within hippa. hippa recognizes the vital role members play a supporting patients with significant

illness, both physical and mental. i have read the family testimonies placed in the record and her heart broken by them and take seriously this committee's desire to get to the right answer on these issues. to directly address the concern that underlined his hearing and discuss the path train to provide for discussed information received to protect the health and safety of other patients. for example, hippa permits personal health information to be used or disclosed that an individual authorization for health treatment and payment of business operations of covered entities. hippa permits other uses and disclosures for certain public health at dignities come along for some purposes and to avert serious and imminent threats to health or safety. added like to talk about disclosures to family members and friends of patients. this is an important area.

or nearly if a patient does not object to information be shared in front of family members or orbit family members or friends, provides a clear avenue. additionally the patient is incapacitated, we mean for that to be given its full part in a meeting. health care may still communicate with family friends of the patient if the provider determines based on their judgment doing so was in the best interest of the individual. this is an important point to -underscore. hippa is meant to revolve around the professional judgment of a provider as to what is in the best interest of the patient. it is not meant to supplant that judgment. diners can discuss the medical condition front of the patient sister who accompanies them to an appointment. if they are unconscious or

incapacitated the doctor can make the judgment to share information with family members. similarly, hippa recognizes professional codes, state laws, professional standards of care recognize the duty and authority to one of situations where a patient may pose a danger to themselves or others or have discussed information indicating a threat in another to either themselves or a third person. in this case is that there's a serious imminent risk of harm to health or save the common hippa has a recognized exception for does torture those cases. when i sit imminent risk, it's not the scenario of an individual going out to commit a violent crime or covers a number of possible scenarios a health care provider particularly mental health care provider may counter.

we take obligations to educate providers and patients on flexibilities seriously and for this reason we have yet took the initiative in january after the tragic events in newtown to wish you a letter to the nation health care providers clarifying these important points. finally, i want to talk for a moment about the nature of which read less enforcement authority. we focus primarily on boxed in a broad-based security threats. we have never taken enforcement action because they provider has decided the best interest of the patient to disclose information to a third party. thank you, mr. chairman. thank you numbers that the committee. >> thank you, mr. rodriguez. mr. rothstein for five minutes. isn't on? poet will close. can you tell at the microphone is on?

daily go. these are government mines, said during a sequestered during a sequestered they are down 20%. >> as is my voice. mr. chairman and members of the subcommittee, my name is mark rothstein. on the faculty of university of louisville and i testify today my capacity and again that they apologize for laryngitis. in my testimony this morning i want to make the following three points. first, the privacy rule is essential to patient care and public health and safety. second, exceptions to the rule permit disclosure of health information for important public purposes and to come additional measures could enhance the effectiveness of the privacy law. first, ever since the hippa, they've established positions to maintain confidentiality of patient health information without assurances of confidentiality, patients are reluctant to divulge sensitive

information about physical and mental health, behavior and lifestyle that could be vital to the individual tree. the privacy rule codified this requirement necessary for ethical and affect of individual health care. health privacy laws also are essential to protection of public health and safety are to illustrate this afternoon i'll be returning home to louisville. at lunch i do not want to cook or server to be someone reluctant to get treatment for hepatitis a. because of privacy concerns. i do not want taxidrivers afraid to get ongoing treatment. i do know what myspace safety at risk repetitively substance-abuse who was deterred from obtaining behavioral health care. confidentiality protection therefore serves to advance the

patience and the public's interest. i though were all deeply saddened by the recent horrific loss of life caused by valent mentally unstable individuals, we should appreciate the potential consequences if their excessive mental health reporting requirements were enacted. each year the united states, there are over 30,000 suicides and over 700,000 emergency room visits caused by self-inflicted harms. an estimated 26 by 2% of people in the u.s. have a diagnosed mental disorder indicate that year. any steps to lessen protections for unnecessary disclosure of mental health information could lead vast numbers of individuals to virchow health treatment and result in significantly more suicides self-inflicted harms an untreated mental illness. second, the privacy rules for 12 types of information of import

to the public and therefore does not hinder public safety. among these categories are disclosures for help that dignities and victims of abuse for law enforcement and to avert a serious threat to health or safety. the public purpose exceptions are permissive. the privacy will does not require disclosures. the disclosure obligations the rest of other services such as state public health reporting on the pier the effect of the public exception is to permit otherwise require disclosures without violating the privacy rule. third, for the last 10 years, inadequate health professional and patient outreach and education programs have led to a lack of understanding the privacy rule by many affected individuals and entities. a common problem is uses and

disclosures permitted by the rule are not about by some covered entities perhaps saturday during third overabundant of caution. the 2013 promulgation of the omnibus amendments to the rule making appropriate time for hhs to start a new program of public and health care provider education and outreach. in conclusion, the privacy rule is essential to individual health care and public health and safety. additional efforts to increase understanding of the rule by the public and covered entities as well as revising public purpose exceptions will enhance the effectiveness of the privacy rule. i thank you for the opportunity to testify this morning. >> let me just ask you questions. during the subcommittee's march that foreign we had a severe mental illness. as a significant not to get what he needed.

one of his sons santos urged him to be extremely high risk for suicide is a bad outcome queered more than one go to share the information with pat or his wife. he took his own life and a missile that should not be to and their son's medical records. is this an example were trained to work as intended clicks >> now, but if hippa her father to the letter that would have permitted disclosure. >> to agree with that, to? does by a physician or provider for mailing information to parents of young adults living with their parents? user now. >> no. >> under some circumstances it might get in the circumstances they would be path for disclosures. >> doesn't allow physicians to provide the antidote receiving

care to the parents health care plan to age 26 as envisioned by the affordable care act? if their sole dependence -- can you tell me where the cut off this? >> the cut off in terms of the patient's ordinary ability to object to the provider's disclosure is the age of the majority in a particular state. >> a fortunate could decide whether the information is disclosed. >> i would assume an early 18. >> are a few of you familiar with the term anosognosia? >> i am aware of it, chairman because i read the majority memorandum for this hearing. certainly going back to the discussion of serious incapacity of the discussion is serious and imminent risk of harm. certainly situations where that

condition either renders the patient to be in a condition of incapacity or rather consequences of that condition been unaddressed or a serious risk of ending up on to health or safety. it doesn't mean going out and committing a gun crimes. it can be a variety of example to the patient. in this case is a patient could disclose without consent. >> would you agree? >> i agree. >> sounds from what i've read of usher said he we may find providers are misinterpreting or overinterpreting laws with disclose names. as such are suggesting is happening here? >> chairman, we've observed in a variety of areas of voice and that there is anxiety about our rules about the law places. if you look at where we take enforcement action, it has been

focused on institutions that have had long-standing failures to protect the security of all the patients in the information. hippa was designed to protect the provider session into the patient's best interests. it is unfortunate misunderstood him about the reasons is that the clarification. >> discussed at the crux of the matter. we would hear testimony from professionals, experts and parents. but if the provider decides not to share the memo with the information for those reasons? what if the patient is inside the release? the patient himself does not recognize they have a problem in the parents would like to have records reveal. i can't release records of the judge says a candidate judge asked the patient patient says no. the patient is at risk for suicide or harm to themselves for not following treatment. what then?

>> wanting to also keep in mind in answering this question is hippa is not the only relevant body of blood. we're also talking about professional ethical standards, the american psychiatric association, psychological association impose clear duties of confidentiality and create exceptions as we do. our rules are built around this ethical duties and see if i duties versus california board of regents. clear plan the scenarios where you describe at providers aware of the risk of suicide, a clear situation where we talk about serious risk of imminent harm, hippa does not have the barrier and the patient's consent. to that person who can last a

very moved. >> ms. degette for five minutes. >> thank you, mr. chairman. if we can all agree hippa provides protections for privacy and we have a history agreement people need to keep their sensitive health information private. we would agree with witnesses, but also we need to recognize in many mass shootings we've seen in many mental illness situations where someone is at risk to themselves and their families. they are interpreting hippa obligations. if they are a danger to themselves or at least, that would be up to the provider decision to advise the parents or other responsible adults. is that correct, mr. rodriguez

collects i just want to say of not going to define hippa, but we should be careful when we contemplate changes to that statue. we heard in march about provider's interpretation and how they can be barriers and treated not just mentally, but physically. i myself as a parent have a diabetic child and even before she was 18 years old, sometimes we had a hard time getting providers to give us information. that's not because of hippa. the providers misinterpret a hippa. when we have a tragic stories today and i'm hoping i'll get back for that, i think we need to take this seriously, but we need to look at ways to educate providers. in the aftermath of the murder of 32 people at virginia tech, with a hippa interpretations preventive mental health

professionals are sharing it her mission. misinterpretations of hippa another of us were identified by the gao and president obama's combat task force as an obstacle to reported individuals who should be barred from gun ownership to the background check system. mr. rodriguez, u.s.a. hhs has tried to be responsive to these concerns that interpretations have created obstacles. is that correct? >> that's correct. >> is sent a letter on january 15 of this year to house providers around the country, trying to delineate exactly what hippa says, correct? tell us why you sent this letter. >> we thought because of concerns about the interaction

between situations are a providers aware of information indicating danger to the patient or others in recent years that it was important to remind providers of both the duty -- permissions under hippa, but remind the applicable ethical standards and laws that do give them a pathway to report the situations. >> hhs advance notice of proposed rule making to solicit comments and perceived barriers to individuals due to mental health yet is that correct? can you explain why the advanced onto several macon is necessary when her mission you're trying to collect? we are just going information from the judicial system which is not covered under hippa.

there is one clear example of states where reporting occurred and reporting prohibited. we want to understand wherein to what extent is the barrier in this case isn't taken the appropriate steps to move those barriers. >> one last question. the affordable correct extended insurance to the age of 26, correct? but it didn't say maybe it's a good question for you. but to the age of 26 or so considered legally dependent of their parents. is that correct? in fact, the provision didn't even talk about hippa, tinea?

mr. chairman, i ask unanimous consent to put this january 15, 2013 mother from the director into the record. >> without objection. >> thank you very much. dr. degree from georgia for five minutes. >> thank you, mr. chairman. and thank you for calling this very important hearing. i'm sitting here thinking as a physician on her of the subcommittee that it's kind of ironic, isn't it that the law passed in 1996, hippa is almost like a hippocratic oath, which of course in the first place do no harm. it has no way to do with

hundreds thousands of years old but in no way does touch on the in the first place do no harm in regard to how you treat a patient, but also the information sharing because it's not done correctly, great harm is potential for great harm to the patient and to the general public. i find that sort of ironic. mr. rodriguez, when is the last time the office of civil rights the health care providers guide to the privacy rule to the website and how about the patient's guide same thing. >> we are updating on a routine basis. as you now, we issued a major role that profoundly affects consumers and providers in january this year.

we been busy posting updates relevant to that rule. >> is a generic 25th row. >> similarly, when we identified after the new town shooting, we took immediate and decisive steps to put it this reminder in which it interacts. >> the fancier questions? t. receive input from the health care providers in this updates quite >> bespeak routinely to consumer groups and provider groups. my doors always open. i took the initiative this morning to connect with several family members here today because i want to hear from them. i want to know concerns. >> i'm going to come right back to you.

are you familiar with these guys? to have a sense of how effective they are? >> i'm not sure how effective they are, but i can't comment generally about the outreach and education program and with all due respect to oci and hhs, we have a major problem in this area but if you read regulations, there are ample places where these issues among the problem of notifying parents and individuals at risk as spelled out. anosognosia is a misunderstood regulations. it's misunderstood by the public, health care providers. >> let me interrupt you to say i fully agree with you that for a long time. i knew that and i think -- in

fact i wonder if some physicians don't hide be timed hippa just move onto the next patient did not want to be bothered in regard to questions about their loved one. i hope that doesn't exist too much. i may go back to the director of the office of civil rights, mr. rodriguez. how does ocr measure? when i was talking just a second ago, it sounded more anecdotal from your perspective. how does it measure whether the clarifications you've referenced january 25 of this year, how do you measure how they were? for example, have a number of privacy will complain filed under the various complaint categories been trending downwards with every further clarification and hopefully this

most recently for the ocr. do you think this to be a helpful match shake to track in judging the performance, your performance of your outreach and education efforts concerning the privacy rules? >> answer the first part of your question, congressman, the caseload has remain steady in effect has grown slightly over the years. we've received some pain of approximately 80,000 complaints since we first began receiving an enough to is fairly steady over the years. part of what's going on is your preference 1996, the rules become final in 2003 and 2005 so there's been a learning curve for consumers and providers to understand what hippa requires that we often emphasize its flexible and scalable, meaning

it's meant to be designed for a wide variety of health care scenarios. i agree generally our case is certainly an indicator. ..

>> and state law requirements?

>> one of the issues i think of our role in this area we are attempting to tackle because we're talking about the duties and talking about the terrorist example is a duty to warn. >> based on state law not the language of hippa. >> hippa is meant to get out of the way of those authorities to be utilized and implemented and in professional judgment to visa hallmark of when disclosure occurs. >> and with the first forums was pta and his sons churning through the mental house system and criminal justice system he noted appropriately a 1963 kennedy

signed a national mental health law that authorized congress to spend up to $3 billion in the coming decade to construct a national network of kennedy and mental health centers and in the nose on the next page that congress never got around to funding of financing community mental-health centers of the process of the institutional moving from state mental health to community-based health care that was supposed to happen instead became a process where more and more people wound up in the criminal justice system we now have law enforcement officers who are providing front-line mental health care. and for those families who have experienced first hand the loss of a loved one because of the ability to bridge the gap especially when a patient is a company to a mental facility through law enforcement officials to of a duty to for public safety in a not provided information about the release of the patients even

though there is a prior history, how do we get to that point* we are protecting the patient's privacy at the same time making sure we aren't walking the disclosure of information to protect the public? >> we need to continue our educational efforts which is widely covered in professional media. so that reminder was something that was embraced by the mental health profession and hippa i cannot account for the code that at least hippa in that situation it does not stand as an obstacle to providers acting in the interest of the patient and public safety. it is worth noting there is a countervailing concern that patients who fear there information will not be confidential won't be treated that is why talking

about that delicate balance that is both our recollections and health care providers are trying to strike. >> one of the other concerns is if we have a child in a divorce or custody proceeding the number one role of the court system is to decide which is in the best interest of the child. that is the principal focus but with adult patients getting mental health treatment who may or may not be able to make decisions about their own treatment needs often times the legal criteria is that the best interest of the patient but protecting the patients wishes from a legal standpoint rather than getting the best treatment option to benefit them as a society. whether the obstacles we need to face?

>> a difficult question of the immediate task is of the individual is confident and if so, health care providers tend to overlook the others. >> thank you for holding this very important mental health hearing especially in lew of the forum that we had with the family members and that was a very important to emotional and revealing

discussion that we had which brings me to some of the questions i have because i am a nurse my husband is a general surgeon and bremer -- hippa can get in the way and as professionals i would say you'd tepid -- typically air on this side of protecting the patient's confidentiality and yourself as a health care professional. mr. rodriguez, since the implementation of 2003, according to my information coming hhs has received over 79,920 hippa complaints. what is the procedure when a complaint comes in? >> the first we ask if it is spayed hippa atoll or another issue outside of our

jurisdiction. we determine if we do we conduct an inquiry and investigation if we determined there were violations of requirements we work with the entity ordinarily with the monetary enforcement program if to correct whatever the deficiencies are in the practice going forward in those areas. wheat received enhanced authority particularly directed at concerns of the security of that electronic health information enforcement specifically focuses on security rather than disclosure issue as it has grown and is a priority of mine to grow enforcement

to protect the confidentiality. >> can you tell me with the implementation of pippa -- hippa has there been significant and lawsuits filed? is that something you would have information about to with allegis hippa violations? i mean against health care professionals. >> it does not provide for a private cause of action. there have been a few lawsuits alleging invasion of privacy or others but hippa does not provide for that. >> the with the issue of health care providers to err on the side of less information is probably better but again, looking

now for the patient and unfortunately having to cover yourself. that is one of my areas of coern with hippa because i believe it is a gray area and left up to interpretation. my final question, and you have a sense of how often hospitals and staff go over a the hippa regulations and is that done on an annual basis? >> it is. we did an audit program last year where another program had a pilot and we found a wide range. some that take those obligations seriously a to assure that new employees are trained but also many providers tornadic is not the case.

>> there again, as unfortunately things fall on misinformation i think this is definitely tone ofse areas. i yield back. >> let me begin by thanking those of you for your testimony it is obvious that you are well prepared. i will address this question to mr. rodriguez following the newtown tragedy obama took positive action in writing the duty for law-enforcement authorities with threats of violence is that true? >> that is true by signed a letter but it was not the president's direction. >> that was my next question was of the executive order? a letter from your office.

>> it was a reminder of the duties under the law and to the administration that they should be fully exercise to protect public safety. >> has that had any impact? >> innocence there has been renewed discussion about these issues and extensive media coverage and therefore we believe based on that it reached those said it needed to reach with the mental health providers. >> how many it went out? >> it was posted on the web site then disseminated through the press religious -- press release through the list served. >> quarter the additional ways to help information technology for economic and clinical health act how it

has improved patient records? >> i appreciate that question. first of all, by bringing business associates within the privacy and security rules. and in fact, there comes into possession of health information away now directly related -- regulate them. it increases the penalties which we have used extensively and establishes requirements that reaches the health information that need to be reported and day cases of larger preaches to be reported to the relevant media. >> my third question is can you describe the training to

make sure they adhered to hippa? >> sure. to my knowledge not comprehensive answer but training is offered at many conferences and in fact, we actually have prepared a series of videos that have been posted and some by the way that are relevant to the discussion here that discuss various aspects if we are particularly concerned about a smaller providers who don't necessarily have the resources of larger institutions so we're looking for opportunities to reach them so there's also a middle school curriculum. >> it is my understanding health care providers must notify patients of their privacy is preached. what methods are used to notify a those individuals? >> ordinarily in writing and

provides for notification for the media. >> finally even with the hippa we heard that could allow individuals to abort treatment could information sharing caused your individuals to seek treatment? >> that certainly is a concerned especially individuals with sensitive information equally disclosed. >> i yield back. >> with then opportunity to join us now have five minutes to rest questions. >> traneight practicing physician and i have a sense you to our incredibly bright

and well versed divorced from the reality seeing 20 patients in a shift in a 3:00 a.m. a person comes in with these issues. i will tell you also they fear the federal government and understand of the federal government comes after them with a long legal arm but she is destroyed in the process. i listen to what you say to allow certain forms of communication but i will also say when i have the maximum penalty 1.5 million and they have their in service on hippa that is what they remember and what they understand it is not permissible to give information you may get in trouble if you do? i can tell you that person seeing that patient at 3:00 a.m. does not have your expertise but examples of physicians who have been

grabbed by the lot and not let loose until every person resource has been exhausted. that is a common frustration with the sense the federal government is denying the entity and that has a great reason to fear some people act cautiously. with that said at of my wrath the doctor may communicate with the family if there is imminent danger. can the family say to the mother of the adult child your son is in taking his medicine therefore we need to do something about that. kim the physician do that? >> again we go back to the serious risks to help there safety. we're not talking about imminent danger in the sense of somebody going out, it includes that but it is much broader.

in the patient's health would be adversely affected with the provider of communication to provide a way to reduce the threat and hippa provides clear authority. >> but assume the lithium levels shows they're not taking the drug can the doctor say he is not taking his lithium. >> we're talking about pieces of incapacity. >> i am not saying incapacitated they are just of the potential verge but they could still think. >> then i think the

pathway, the results of that are consequences for that individual self for those communications. >> there seems to be wiggle room. i am not sure if they would find a safe harbor with that answer. >> the greater safe harbor is we received 80,000 cases only 12th have resulted in monetary policies or penalties. >> but seeing 20 people per shift does not have expertise that is a reality. what you hear at the end service if you violate veto and able to renew every which way but loose. i have spent there. >> with love to see those because those of not consistent with the enforcement history.

>> it says the health care providers are not permitted to share personal information with the family or friends of an adult who tells the provider not to do so what if they are incompetent? what if they are not listed? they think there are black helicopters circulating and the mamas and the pilot? >> that is why i mentioned mentioned, certainly with incapacity it can include a situation where a patient is far from lucid then there is a basis. >> sometimes lack of lucidity is in the eye of the beholder. there is a "wall street journal" article about will young bryce or bruce were the man was released and killed his mother with a hatchet. clearly he was considers the city enough to leave.

sorry i about of time i yield back. i am sorry. >> everybody is permitted one additional minute. mr. rodriguez the state said confusion over hippa has prohibited said -- them from sharing 1.5 million records with the national background check system for those who have been involuntarily committed or deemed mentally incompetent by a court of law. prohibited from owning a firearm. the committee sent a letter to hhs asking about hit the -- hippa interfering. i know it has now announced it will solicit feedback on reform. widely believe states are not applauding those records? >> i have heard of hippa one of several different reasons.

i don't understand it to be the only reason i know certainly in new york state fair reporting woudave had come out of the hippa covered entity so reporting would have never inhibited we now look to eliminate that kind of barrier. beyond new york i don't know. >> could you give us a written response to clarify? thank you. >> we were talking earlier of the challenges faced with the incredible burden with law-enforcement officials officials, led the penal system with front-line mental health care this is the dramatic shift with what has happened since congress passed legislation to promote community-based mental health so we now have an experience of people who care about the rights of the mentally ill or care about

protecting public safety want to know what we have learned as we try to create a balanced system protecting the public have the right set to get the best possible treatment when we have been failing. what key and we do? >> that is a difficult question. we need to increase the funding and where was all of community health efforts for sure. what we can address is the importance of getting out the message of what hippa does or does not require. one of the problems overall is hippa was intended to be a floor that state law would take place but with many areas it is the floor with nothing above it.

>> you can offer a written response. >> item number i can do this in one minute that quickly, on january 25 hhs published a final rule to make does significant modification for purposes to identify health opportunities. many drug companies use third parties to help identify patients in need of care for purposes of the inclusion of clinical trials. some of those including my own district have chronic illnesses. would this still be allowed if such a third party company did not burst the patient's consent?

>> thank you. i yield back. >> i am a little concerned you mentioned 26% to have been diagnosed of a disorder in one year if you talk about serious mental illness it is a smaller percentage than those are in competition. believe me. i speak of personal experience of friends in this situation is a bit disingenuous for a group truly out of it as opposed to the 26% that has depression or would it be more honest to focus on that group for their sake as a unique group? >> if legislation were enacted that made all mental health records more

disposable. >> cell under very guarded circumstances as opposed to the brodeur 26? >> by a merger of the discouragement. >> who has bipolar oftentimes we have to be honest. they have been acute break as someone who has had patience as a close associate i yield back. >> thank you so much for being with us today. misery ask people to get ready for the second panel and continue with the previous hearing after newtown and also hippa we are exploring the issues of a wide range but to make it

there a clear for the audience to those watching at no time does this committee at any time communicate that those as mental illness that is a response for violence. we recognize that they're more likely to be victims of violent crime is very important we understand that. the second panel we have dr. dr. martini and its share of department of psychiatry. for full disclosure was at the children's house of his third he was one of my students. how time flies.

also dr. carolyn caffeine -- levine and especially during transition health care settings and then mr. wolf is the father of a son who suffered from mental illness and mr. kelly is also a father of a sudden with mental illness. >> i am thrilled to have one of my constituents testify today from parkersburg iowa has a story to tell about this gentleman feature did sports illustrated after he was gunned down by a former student. the nfl national high school coach of the year with four of his former players playing in the nfl and she has an importance story to share about these issues. >> and then may have misled grappa calls privacy project as you are aware of a

committee is holding an investigative hearing and may take testimony under oath do you have objections? please share prices under the rules of the house you are entitled to be advised by counsel if you desire today. in the case please rise and raise your right hand and i will swear you in. dues were the testimony you're about to give is the truce, the whole truth, nothing but the truth? all participates -- for japan's answer to in the affirmative. you are now settled fourth bananas states code to now give a five minute summary of your written testimony. wait now recognize dr. martini. good morning chairman murphy members of the subcommittee

didn't thank you for inviting me to come and speak with you about hippa as implications in the discussion. from my testimony i will review patients' memories based in my clinical experience but do not include easily identify all information in. they're more straightforward if a patient is a minor and not emancipated parents are primary care givers are involved in the process to support the patient and guide them with psychiatric care. not typically recognizing the nature of the problem and this is one reason. as well as other pediatric mental health professionals we know this improves outcome. all pediatric specialties struggle from adolescence into adulthood to a period of almost all autonomy for

coming here not prepared for their responsibilityo chronic medical illness and psychiatric disorders. they have provided a framework for many aspects. one patient has a mild form of optimism and developmental delay determined to move out of the home once he was employed. the parents knew he could not manage his money money, emotionally reactive and could not track medications nevertheless he did not want parents involved was routine care and they had to go to court to state that there son was not able to care for himself. unfortunately the ruling in their favor was counter to our goals in the real progress in there three. psychiatrists spend a lot time negotiation communication we don't want to discourage care especially those want to seek treatment.

so with those options available so some suffer from a congenital kidney disease and in and out of the hospital. they were a great or depressed over thus transplantation and i wanted to involve but he refused because he was concerned how disappointed she would be after everything they had gone through together. they had dropped out of treatment because it was too difficult to years later they ran into a position they discontinued medication he went into renal failure and died so you should be able to understand under the legal limitations of hippa

but also work with the patient and the family. those at risk with a significant change of the intent of the law but must we wait for a patient to be considered at risk before seeking help from parents? rules of confidentiality affects situations that are more common allowing adolescents and young adults like going to college. they're told even though they're paid the bill they do not have access to medical or psychiatric information without permission and one patient with heart disease and depression wanted to go to college she prevailed but did she began to deteriorate the student health center knew she was ill but could not contact parents. if she had a serious disorder the family may not find out about it until they received a bill 30 days after the event. should be to parental

involvement? mental health professionals to the best interest to preserve his or her right under the law. regardless of the patient wishes to suffer others thank you mr. chairman. >> thank you very much. chairman murphy and members of the committee thank you for inviting me here today. i am at the other end of the age spectrum and work with family caregivers of other adults with multiple chronic illnesses and i think the importance of my experience for your deliberations is the misinterpretations of

hippa that we heard about are far more pervasive about the questions of mental illness. there are 42 million americans taking care of the chronically ill parents and i cannot tell you how many times i hear from family caregivers who has a parent in the hospital and family members expected to do wound care, multiple medications, monitor machines and the care coordination in the community and when you ask what do i need to do to do this? i can tell you because of hippa. that is wrong. why? because the two features

there is the training that emphasizes the scary aspect of hippa often done in a way if you say anything he will be in big trouble. if not then the informal communication from the of mid-level staff. they're terrified they will lose jobs meanwhile laptops are all over the place they don't pay attention to the actual security of this information. also what is very pervasive is it is a convenient excuse to avoid difficult conversations. it takes time, it is uncomfortable and has nothing to do with privacy and it has doo-doo with why

do i have to talk to this daughter? that is fine if the patient can understand but 85 rolled woman with congestive heart failure in moderate dementia and 65 other medications cannot absorb that information. what we really need is far more education on a balanced level. it is instructive fennecs care and web site with the most downloaded guide to hippa there looking for information. hospitals and the coverage entities need to be encouraged to have understandable information to the patients or their families and everyone vague deal with.

you will get several pieces of paper to barely understand. those that would be able to understand with what we can do with your information is not about protecting the patient and the ultimate question is whose interest is being projected? said staff members to not get into trouble? i appreciate that north the institution's interest not being in trouble? those are valid but they should not override the good clinical care older people people, younger people, everyone needs to get the best possible care for a very pervasive problem

but it is a waterfall. and we continue to hope for more. thank you. >> good morning. my name is craig will ceo official court reporter for the state of pennsylvania so i can address a lot of legally emancipated adults about the mental disorder disability or drug or a politician. with the hippa lot as a positive impact on society. my son was gregarious and affectionate and compassion and an intelligent young man whose life came to ascended end 2012 from a heroin overdose at that age of 21. he had attended syracuse

university to carry the 3.zero gpa that added abruptly to the abrupt behavior he had see a therapist with a ph.d. and then cited a. and was placed on admiral. one discovers the affect of the results that the treatment could not care. in 2012 justin told his mother he pluses addicted to prescription drugs and to come to us doctors out my request and also when his mother was not present stated he had been using here when for a few months prior. he did not when his mother to be informed of the heroin usage without disclosure the doctor expressed dire concerns do take any deadly to recommended crisis center but justin convinced his mother threw his manipulative behavior to

taken to a doctor that he knew of. he would not allow his mother into the tree ran there he admitted to using here when andy was prescribed the drug. two months later i was only warned of his. said addiction and implored him to enter into drug rehabilitation. he was working two jobs and cannot attend treatment and he also convinced us was helping him with his recovery after another month he finally hit rock bottom and we finally gave him the ultimatum he entered intensive outpatient treatment then i inquired by his progress informed he did not disclose any information under hippa i was frustrated as i could not be apprised of my son's condition. during the five week rehabilitation i sent him to see inexperienced psychiatrist weekly that

continued until his ultimate decided -- demise. he tried to counsel and give medication for his anxiety but i learned he had not disclosed his hair with addiction except to say he tried it once. with those medications found untouched he continued to take anxiety medication just to return to school last fall he even joined a fraternity where he was pledged and supported however he was terribly and secretly added to do here when and died of an accidental overdose just a few weeks later. no one was aware he was using here when. everyone was in shock and disbelief but it was to lay. i confronted numerous parents and nine out of tin did not realize snorting and was an option not by injection.

most are shocked to learn it is only five or $10 a bag and it is cheaper to buy a bag of hair when than it is to purchase. set he came from affluent suburb and into camp in new jersey and sold personal belongings and mothers stolen items and i even learned about this after the fact there reading text messages i requested the exception allowing parents to maintain legal residency living under their homes under their care or under their health insurance coverage that i specified until the age of 26 for the following reason. any type of addiction and mental disorder could be life-threatening and to society as with the columbine or aurora shootings he was never file

and not intentionally hurt a soul but unintentionally it was cut short including his younger brother who was said type one diabetic. after his passing he told us of the reckless disregard as well as conducting an attitude -- activities i have pictures of his apartment from the last month to show how he demonstrated including cigarette burns that could have been injury or death and his stepfather had taken taken him a target shooting had we known about the heroin addiction he often ask my permission to become licensed that i was against however i am forever thankful for not allowing it especially now that i know he was using the drug. >> we are out of time. can you give a final summary

>> i have very important information 93 of four minutes. >> it was the result of the year when addiction it is the only way to experience pleasure in one becomes numb to all other surrounding emotions. the drug-related death from the drug overdose kills 30,000 people making drugs a more common cause of death and drug czar alcohol and homicides are mostly the result of hot firearms. fifth accidental drug overdose is the second most common cause of death from homicides are hiv/aids. went imager prefrontal cortex does not develop until 24 years old to understand it is dangerous to still go under or risky

behavior and those with disorders exacerbate that behavior. parents know what is best for theirchildren given the appropriate medical information to exercise judgment and guidance. another to help parents president obama and new jersey and congressional leaders to call attention to this issue to lobby for additional language that may help protect young adults from harm. parents cannot operate in a vacuum without knowledge of those mentally disabled children to not have the wherewithal to think rationally for themselves. the absence of rationale could have life-threatening decisions are premature death. if it had the public health safety built in the attic to be disclosed about the individual's consent without serious threat to holders 50.

they could disclose information that is necessary to have a the threat when such disclosure is made including the target of the threat. should stand to reason it is prudent and necessary for inclosing same year requesting the following language be added to avoid ambiguity of parents are legal caretakers of the emancipated until with mental-health history or drug abuse continue to cover the minor with health coverage or continue to support them financially has access to their health care records through the ages of 26 to protect them from harm although his friends and family could not save them it is my hope it would change the situation to save millions of young lives that mental disabilities recap quick and affect all socio-economic backgrounds when you look at the famous and intelligent people whose lives are taken due to drug

abuse this country has lost a wealth of talent and success which would have been an et to t row of our nation. thank you very much. >> mr. kelly your recognized for five minutes. >> thank you, mr. chairman. i am the father of a paranoid schizophrenic son diagnosed at age 14 and i am afraid i have some harsh news and points to make that will fall in line and i think the congressman to the point* because of on learning of this diagnosis upon educating ourselves every aspect of mental health treatment included in navigating the system with all the things in our way in return upon ourselves to educate others. a have taught classis, serving on boards thomas speaking engagements, raising many in

bringing people into our home to help them. what i will tell you is we are ashamed of ourselves as to what we did not know before our son became mentally ill. i would dare say if the members of this committee would stay with someone with psychosis you would change things tomorrow. what needs to happen is recognition there is a gaping hole i will clarify there is a difference between mack of insight and a psychotic episode. they are two entirely different things. lack of insight if you refuse treatment and you don't want anyone to help you most important the family members brothers are sisters are grandparents, so what happens is you set a stage for tragedy literally propping it up because there is a gaping hole where we try to just address the need of the severely mentally ill the same as the mainstream

mentally ill and it does not work. my son and has been to the u.s. marshal looking for a gun he thought he is the secret agent to this day he is naked in the snow and living homeless under a bridge sheathings my wife is a stripper and a prostitute. for an entire year he did not believe we were his parents. you tell me this individual can possibly make responsible decisions about his care. but when he gets into the hospital sometimes we all have their recent history to give the new hospital, by the way he has been in 14 years, eight hospitals and dozens of different times. you have a broken chain of treatment so imagine the medical system where physicians and treatment providers cannot rely on prior history to treat this person. it is beyond comprehension

and with stifles accountability. when i tell you he people hide behind hippa i am a 14 year educated man only the grace of god there is a plan out there for us to make a difference that we're sitting here in my son has not killed himself he is more likely to kill himself than he is to live the rest of his life with his illness. so treatment can be delayed or not all. my son is gay from a mental health facility in it was locked hippa was thrown out the window they tried to find a bank records and please call the samba hospital called as they found him four years later and they dragged him into a state hospital with shackles any verbally assaulted said judge and put on suicide watch incomplete the art of it than when the time came we were precluded because of

hippa and that panel said we cannot do with the hands are tied to days later a patient or a staff member was killed in his swing we don't want to know what happened he was one year. one year in that facility. the views and the things that happened to him and that hospital and they never ever lets us in. when he became 18 we were the enemy. we have doctors who have shared with us behind the scenes they knew they would be in trouble that we will lose there jobs but we have to tell you. members of our community and people no less. people to chances but outside we were left out. the other thing is imagine someone mentally ill being discharged back into real society even under the best plan with families being involved is a very difficult process.

but take a look at someone who is not part of a discharge plan without a support network. our son has been released and put on a bus and we haven't found him four weeks. hipaa empowers homelessness. my son has been gone no money foreclosure, nothing. gone. in shelters. gone. why did you tell us? we can't. hipaa precludes that. the whole idea they have to tell us the threat? celebrity decided he is not a threat. we search for him. the shelters cannot tell that they are there then the next thing is this person who has been released you want them released like this. no support isolated in fear, a frustrated, angry and we are the first target. people are released every day without discharge plans involving the family and they have no way to transition back.

you don't want someone with a psychosis as a symptom that pops up than the idea by the way it dissipating in predicting when imminent danger is coming, i just bought this state of maryland to get that across not one person on this planet can predict the tipping point* of someone with a severe mental illness. you can do it. you try to rely on who? the people closest to the person which is the family but they can't do it. we cannot give recent history to the next hospital or doctor because we can get it. so we have less ability to help so the idea to provide information and doesn't exist. it is scary in closing i would like to say hipaa has a lot of gaping holes. this is the biggest. there are ways to beat hipaa we seek to hide it which is bad our sons and others deserve the right to be proactive and form

themselves so they are safe in their child to save. >> thank you. >> first of all, i would like to thank congressman bareilly to come to washington to tell my story and chairman murphy for holding this hearing today of this important subject. my name is mrs. thomas my life has not been the same since the tragedy occurred and a change a life of my family and community june june 24, 2009 was started off as a normal morning was the beginning of a nightmare. a 24 year-old former student walked into our high school weight room and in front of 22 students and indeed his gun into my house when he died on the way to the hospital. he was only 58 and had taught and coached 36 years.

when quick chromosome many lives were impacted trevor roper family lost a son, husband, father, grandf ather and brother. the students in the weight room along with extended community lost a mentor, a friend, a teacher, coach. a sense of confidence and security of the horror will be with them forever. in this youngster's including our grants and suddenly realize the row has a dark side and taught a horrible lesson that bad things to happen to good people for no reason. they were robbed of the deep love of their grandfather and the experiences they could have had with them. my sons lost a father i lost my husband thought and we miss him every day. but the real tragedy is the fact off this could have been prevented.

only four days before ed was murdered this a man rammed his car into the garage of an acquaintance and break his way into the home th a baseball bat. then police arrived and leading a high-speed chase then taken to an area hospital for a psychological evaluation. less than 24 hours before my husband died mark decided he did not want to stay. so on the advice of his doctor he was dismissed. no one knew. law enforcement was not notified even though they requested the hospital let them know when he would be dismissed. the justification for not notifying law enforcement was hipaa prevented the disclosure. even his parents did not know until they were called and mark call them later that evening. no one knew mark was released but his privacy was protected. during the investigation it

was revealed mark had feelings of animosity and resentment. we did not know that. if he had come to my home that morning i would have instantly send him directly to him and to his grave and to think that i would had to of live with that the once again marks privacy was protected. mental illnesses cannot always make good choices concerning there treatment or actions. they may need the help of a family member or other responsible parties to make sure they received treatment they may need outsiders to keep him out of harm's way bet do to teach and even his parents did not request information or help make decisions for his treatment. so is the privacy of more individual more sacred than apply for the welfare of the general public? is a more important to let

all law enforcement know when they are released back into the community they risk there life every day to protect? said was an inspiration to so many and most importantly a loving son son, father, grandfather, a brother. i urge congress to update the law to prevent further tragedies like this one. thank you. >> you're recognized for five minutes. >> i appreciate the opportunity to think the chairman and subcommittee for focusing on these issues that are critical with the organization for the non-profit public-interest advocacy organization on behalf of consumers that we like to think of privacy as the incredibly important role those who are from stigmatizing treatment

actually get into treatment and many express that if they didn't have some guarantee of confidentiality they would not seek treatment that is the reason why we have privacy laws. not to create obstacles but the treatment environment that people with stigmatizing conditions want to be an but they are not absolute. they have lots of exceptions and the previous panel talks about them as well to allow for the notification of persons and a serious and imminent threat and notification of family members except in cases where there is an objection by a patient who has the right to. the there is an adult or the emancipated minor or in some states that allow minors to

consent for treatment on their own. . . so for people to blame this on hippa is incredibly frustrating because hippa does allow disclosures and where the disconnect is have a name is

radically frustrating to me. i am a privacy act kick, but i believe in the reason for these exceptions. we try to take a balanced approach and understanding the reason why they access for whatever, admit that you can't disclose to family members. again, they are not out by the potential for serious and imminent threat. it is the case that an individual at jack's come again if they have the confidence and power, that would be the case you couldn't disclose. i would say more often than not, there is began the experience of the folks at this table notwithstanding people want their families involved in their care. i've had people say to me, my elderly mother who went caring for, i would like to have her doctor talked to me about her treatment and office is telling the hippa will not allow it to happen.

that is so untrue. so i am incredibly sympathetic to the frustration of people who were told that hippa requires something that it doesn't. i am trying to figure out what we can do better in terms of educating folks about what hippa does and doesn't do. too many people hide behind it is circumstances where there are clear exceptions that would allow for that information to be shared. some of the testimony of director rodriguez in the first panel frankly was a lot more -- i had a lot greater understanding of the exception for family members than i did before the hearing. that suggests to me this guy than, which i think is good. the latter is serious and imminent threat. this is guidance about what can be shared with family members because information to be shared

with one or more family members for a close friend helping to care for them doesn't happen. it could be made more clear frankly they could find better ways of disseminating items. i know where it is on the website, but there's lots of folks who can find it, who aren't aware that it exists and when faced with a person in a health care facility telling them something they unfortunately believe are trained to want to information to be shared when in fact it does. i'm happy to answer any questions i appreciate the opportunity. >> i want to also say here our hearts go out to the families of mr. wolfe, mr. kelley and ms. thomas. we're going to recognize for five minutes. i want to make it clear, ms. levine had opinions in her testimony. you're not a licensed provider,

am i correct? d not practicing therapist. >> not at all. >> is important because on page 10 of the written testimony, he said the doctors don't want to share information and is a convenient excuse not to tax families are listed to what they know about a patient. it's easier to avoid typical conversations about prognosis and treatment options. dr. martini, is that true? they don't want to talk to families of the typical? >> now, the vast majority positions are interested in sharing that information and very much want to involve families and care. we know for psychiatric patient their prognosis is improved at one of the ways i look at it if they see a patient at the most an hour a week in the family stood with individuals on an ongoing basis. any recommendation as a clinician is more likely to be

successful if i'm able to get support of the family. >> just wrote briefly in a worker to, also from your stand point because you talk to providers about these cases coming to you think the providers did not want to talk to make it or felt they couldn't because of their interpretation of the law. >> my family physician told me later and he did want to disclose the facility was under the obligation of the hippa goes not to disclose it. >> import seniors have never encountered a situation where provider did not want to disclose. he was secretly tell us not to. >> i can only speak for what law enforcement told me and what experience have told me about and they all had difficulty getting information. >> you heard from mr. rodriguez, sounds like he's saying the law is adequate and the problem is providers aren't aware of the

law and are unjustifiably worried about lawsuits, perhaps administrators who pressure stat not to disclose information to be fired. is it true that it's adequate to read a lot a sword and in terms of the way information gets to providers? >> i don't think this adequate aspires to writers because both of my sons case with the rehab situation as well as my family care situation, both after deceased i confronted them and they said they would've sent them and with regard to informing me. again, with him signing the hippa disclosure they were not permitted to appear at i.t. field they did have an obligation menu is a life-threatening situation with the use of. >> thank you, mr. kelley. >> in all due respect i fear there's a significant detachment

from reality. mr. rodriguez. it is underlined unless the patient of jack's and seven through the mentally ill, back at your not the one know and the fact is that we need to have exceptions. it's just plain and simple. >> i can speak on behalf of the fact i'm a volunteer emt for community and the threat of lawsuit prevents a statement from the unlike we are able to tell family members conditions of patients who =tranfour. so with this misunderstanding has emphasized in our training. >> in a written statement he said 17% or 39 lipitor information from health care providers due to race about how information may be disclosed. the study was on general health issues, and i correct?

>> in the time i had to prepare for this testimony i looked for more specific statistics on persons being held back from seeking truth and for mental health. i didn't have enough time to time nothing directly. i did find something on the mental illness website is talked about two thirds of people with mental illness do not seek treatment or a number of reasons. lack of knowledge, fear disclosure. >> i'd be happy to keep looking. >> we have folks here also saying doctors didn't disclose information and people are overinterpreting the law nisei perhaps patient are also overinterpreting that it would be disclosed. he said it's badly mangled. what can be done to clarify above? to many legislative language quakes to nisei caselaw?

more public education, what do we need here? >> the badly mangled part was the reference to the fact we had all this testimony about what his entry into and people are told in fact it is not indicted not a significant consequence is. more tenants and batteries of disseminating so you don't have to look hard on the website absolutely is the first step we should be pursuing here. ideally that could be done in conjunction with societies who have affect mechanisms for reaching their members. having read this guy and, it's clear but it could be made more clear. more examples in this circumstance you can do x. >> we look forward to your specific recommendation. mr. braley, five minutes. >> i should also note that it

comes to sister connie flaherty is in the audience today. this has impacted her smile. some of the things you're testimony brought out is the misperception are unique to lurcher in areas with a higher concentration of people seeking treatment for severe mental illness. parkersburg is the time of 2000 people. five years ago this may it was nearly by an f5 tornado in your husband was one of those people who rally people to combat, but the community back together in one of the other things that is so important is mark becker is someone you knew very well. >> we've known him his entire life and his parents. i know their frustration in getting him treatment, but i agree with what they are saying when it comes to mentally ill people come your client pacify them a wonder with cancer or

hepatitis a those things because they think it is not rational and their baby needs to be exceptions to those rules. >> one of the things we know this from the stories that have come out come the u.n. had been to church as mark becker's parents. it's not like it was a stranger in your family. the bakker family has expressed frustration in trying to get the help you need an so he could put his life back together. that's one of the most disturbing things about this topic is these are stories we hear over and over again and it points to a breakdown in our ability to get people who need it, the services they need in communities all over this country. one of the things i'm really interested in is how this

particular tragedy in your life has changed how people in your community think about problems have been talking about. >> it's hard to speak for other people, but i think there needs to be more awareness of mental health. this needs to be expanded quite a bit. i don't if there's enough resources for people. the fact no one knew mark was released any threat was frustrating. it wasn't just our family. this young kids are 14 and 15 years old that witnessed their coach getting shot down at close range and cold-blooded all could've been prevented. that's a big frustration for a lot of people. he was not able to get out of harms way and he was loose on the streets because he wanted to be. >> one of the other things this points to defend that for someone with a severe mental

illness 40 years ago when i remember the stigma attached to mental illness then. would like to think we've come a long ways as a society in dealing with mental illness at some injustice real and impacts to both sides as much as other diseases. the reality is there's still a lot of stigma attached into that to avoid having conversation unless it impacts us personally. i want to think the panelists are having the courage to share your stories. i know it's been an incredible challenge for all of you. one of the things that talked about earlier is this challenge family members have adult children have been able to have a role in making decisions about their care when there sometimes obstacles. you talked about this a little bit. one of the questions i raised earlier is whether this risk to self or other standard is still viable way of getting patients

to help they need for a truly effective treatment. he gave examples of both sides he story. her intervention was counterproductive. one where they need was not provided. so how do we resolve this? >> what i would like to do is think about what she just referred to in the best interest of the patient. what do we think will help the patient must in their recovery? i understand there's issues around confidentiality and patience are sensitive about that. we're not talking about a release of information to the community. looking at cases on a more individual basis and deciding if dissipation is going going to do well, what is necessary? what information needs to be

shared? should it be shared with family members? were to be a good idea to share information with the position and their communities quite often coordinates in a variety of ways. to have any local connection. it's the same interest interest of the patient. >> thank you. which you submit that for the binder source in the record as well? >> i'd be happy to. >> that's got to be the fattest. i now recognize or five and it gentlemen for virginia, mr. perfect. >> if i could pass this time it appreciate that. >> thank you, mr. chairman.

first of all panel members said they too reiterate thank you so much for being with us and your testimony. i know these are tough testimonies to give in our hearts go out to you. ms. levine come you suggest health care workers use hippa as a reason to not share information that because they're afraid of fines or sensors. why else would someone withhold information from acquiring family members? >> well, the role of a family member in the care of someone who most of my experience is with older adults, although i personally was the family caregiver for 17 years he had tonight brain injury must quadriplegic. i have my own experiences with the system.

family members ask hard questions. they want to know why did this happen, what could i expect? why are you giving this information and is contraindicated. i can't tell you and this is not to disparage the nursing profession because they are fabulous, but i've had so many nurses say to me, are you trying to tell me how to do my job? yeah, i think i am because my husband should not have this medication and that medication. i tell you how many physicians and nurses have said family members surpass. they are nuisances than they are. they ask the hard questions. the patient of medicine pain and not going to be trouble.

it's a truth universally acknowledged that family members are working on the tape discharge to get them home, but not necessarily in the course of a hospitalization. but i really tank the hippa scare and there'll not be a high-tech scare because mrd getting e-mails saying we are going to protect you from this horrible audit that will happen in the foamy virus to be safe. >> and industry crops up. it's not one thing. expecting support each other. >> when i quickly got two other questions. it is to reinforce the providers to provision protected health

information in the family caregivers or others who are going to be responsible for providing, managing or paying for a patient's care. how do you suggest ocr go about doing that? >> i agree the website is one way but not the best way. there can be involving medical professions, the risk managers who are doing a lot of the training, involving the leaders in saying this is not good patient care. we are concerned about hospital readmissions. one of the reasons people come back in 30 days and cost medicare money is the member service on civil for that care don't know what to do so they bring them back. >> to your recommendations for cms as well? >> yes, definitely encourage participation in medicare to

make sure they are responsible for training the hospitals and nursing homes to train staff in a balanced way. one more thing i didn't get a chance to say. >> quickly running out of time. when we encounter the context of providers patients who object to having a family member. it has nothing to do with privacy. i don't want to worry to have any responsibilities. >> you the served the clear culture how does this impact decision-making by health care workers and facilities tasked with taking care of your son?

>> it's more than one hospital, sir, but essentially we are not able to defend terrific things from happening. we've had discussions with their knowledge due to the privacy rules we try to emphasize to make a decision and it doesn't phase them. what happens is the patient get mistreated, so is pervasive. >> ideal that. >> thank you, mr. chairman. affect payouts to know i've read all of your testimony even though i listen to your to hear you say it. but those of you who have lost loved ones, my deepest

condolences. i think that in my opening statement, i know how difficult it is to have a chat with a severe illness. my child has a physical illness, not a mental illness in his now a freshman at college. i note you're talking about in your testimony of the parents pain college tuition and obviously that the child and are deeply concerned. yet the child is over 18 and want to become independent and they have privacy issues. if a heart alencon new deal with mental illness, which has been learned from professionals bipolar disease manifests at the root of some of the violent, most notably suicide the

evidence between the ages of 18 and 25 and in young women at a slightly older age. this is right at the age where they become independent from their families and most of the time are over 18. so it's a hard talent because i'm the one hand it's like ms. mcgraw was talking about. you want them to get medical treatment in on the other hand the spirit we want to know if they are at risk to themselves or others so it's a balance. companies say just a moment ago struck me, which is trying to grapple with this issue, he said we need to look at individual, that dr. to look at the individual case is to see if this is a situation where having parental involvement of another

response will appropriate to let them know. i agree with that, in listening to the testimony of the last panel is exactly what they were saying. and their interpretation that's exactly what medical providers are allowed to do. i think what we need to do is providers need to understand what their abilities are, when she recruited that? >> that's an important part. i think in a way that makes him like more of a collaboration that this information. they can make a case is an overrated aspects besides this

situation is worthy of that. those initiatives were hippa scene is not a government regulation, but a process they can participate in. if we still have our hhs witnesses here, we should also have federal agencies were with colleges because a lot of problems trying to balance the privacy protections for student and also letting parents know. they would have leeway would have to let them know that. >> there also needs to be help for them. some thousands of miles away would be a challenge. >> discussed at the last thing i want to talk about because it not just the hippa issues.

some of you have seen this in your communities. the assistant came in and she said she had a 19-year-old son diagnosed with bipolar and he had become violent. he put himself into a 72 hour hold and then he was released. about despair and. they couldn't find any mental-health treatment. this is another issue as well as once you diagnose this you've got to go to find treatment. you probably agree with that. >> i think i convoluted to this, we need to work on access to primary care. the majority of the mental-health problems are treated by local physicians

donate to work with them so it begins locally. the next thank you, mr. chairman. >> thank you. appreciate your patience. you're talking about professionals involved in trying to make sure people get treatment. what are your thoughts. can hippa stand between the mental-health professional and a patient's general care physician? there have been cases where the family, the patient does not want to know in part because the positions knows a great many people. a good bit of anxiety is misplaced, but i can understand it. we need to work with these local

clinicians and physicians to involve them in mental-health care to make them part of the health system subfamilies recognize that help theypovide will be in the best interest. >> we heard it takes 18 months for the average gc in mental-health professional and not the concern and something we need to address. the physician might be able to short a time. they make them referrals and running as a a trusted family physician, they can be helpful in that regard and following up the professionals not in the media community. the mental-health professional may be the next community over.

if they can't communicate with the local health care provider, it does create benefits there. why do you think such communication is important? >> i think what it will allow them to do is receive services more efficiently. the local practitioners understand what's available from the standpoint of medical services but also the community and schools. but we need to do is work with and to teach them what they can do to get uncomfortable and their practices. and teach them when they should prefer to us. as part of that would need to be available and that's a big

question. we need to do this in a much more efficient and effective way. >> i noted in her testimony to fear of liability coupled with misunderstanding can be a recipe for not sharing. if you're familiar with and i hate to ask, are you familiar with these to go the other way, where permission could've been granted. police have made the determination to use to shield to say we couldn't tell the police any pain. tuccillo considers surinam permit in this dangerous person on the streets that they would've a lot of? >> hippa does not have any

provisions that enable anyone to pursue an enforcement. privacy rights are some unknowns of overinterpretation. keep in mind allowance of disclosures as per message. it relies on health care fighters to make a judgment call of the best interest of the patient. we need to keep in mind tranter missed the floor and medical privacy statues to impose liability in the circumstances. except very patient asks for about them. you can be held accountable for not doing that. >> my concern is that is one of the ways people like to hate

lawyers and that's the one leg at rectification. in may keep somebody from making the mistake again. we have an individual in your case to the police bring in as just run his car a garage. they bring them in from a psychological evaluation and even though the police asked for notification. to me that's the classic definition of negligence. >> as far as looking into the lawsuit are unable to get mark's record. it really was that going to benefit anybody at that point in

time. >> nisha teske for five minutes. >> thank you, mr. chairman. first of all, i just want to say in future airings or other events will clear testimony and participation from the patient community -- [applause] i know there's a discussion right now. >> we are not permitted to alpers. i ask members not say things that might provoke outbursts. continue on, go ahead. >> another some discussion about including written testimony highly fit noted into the record and i would suit you recommend that be done without much ado.

and let me think actually the family members who came here with their stories. and it's much appreciated. i want to understand the examples that shoot. you had a patient, a former patient with a mild form of autism and eventually his parents went to court against his wishes because they said their son could not care for himself and thus remain dependent. unfortunately the ruling in their favor was counter to the polls for psychiatric treatment and derail progress. so are you saying that was a bad decision that the son should have been able to do what he

wanted to do? >> no, i was saying because the sun would not allow, nor in therapy. i couldn't incorporate them into any programming is trying to organize, could involve them in the medications he was prescribed. they had serious concerns about how he was going to function. because he continued to refuse to allow them to participate, this is the only recourse they had. the purpose of the therapy was to make it more functional. >> i understand that. you're saying if they had been involved earlier i understand that, but at the point of making

a decision about what they want to do, been trained to understand what a better outcome might have been and could it have been done without having to go to court? >> is one of the reasons i put it in there because i was searching for another race to have a better outcome without having to go to the court. if there was a mechanism similar to the thing i mention in tennessee with an opposition to appeal or present a case in front of a review board involving hippa to say this is what's going on, it's in the best interest to have the parents about actively participate as it's more likely the individual will be successful. his life is going to be less traumatized if you have an

opportunity to do that and a means to modify with happening with the hippa regulations in these cases. it would be an advantage not for the family but also the patients. >> if there is a bias in a situation, should it be parental involvement rather than away from it? what do you concl if there is a bias, should be tourist parental involvement rather than away from it? >> my bias has been to involve families. what about families as often as possible and treatments in for a variety of reasons that this going to be a bias, my recommendation would be tourist family involvement particularly if there's no specific reasons,

nothing that would adversely affect the patient. >> i am not weighing on either side, but there's people in the independent living community that would feel a young adult with autism that there may be some better way for the individual to live in the community for support, et cetera rather than dependent at-home. do you see that as part of the negotiation that might involve everyone? >> absolutely. and this particular case, the goal was greater then. with the hopeless and treatments you'd be able able to manage affairs, but the level of anxiety he felt would go down and we would increase the capabilities he had to manage

his medication. the sense of having parents involved would've expedited the process. >> thank you. i yelled back. >> thank you, mr. chairman. i would also like to say to the panel thank you so much. i'm going to get emotional -- for coming to share your stories because this is the only way will change anything in mental health and i know how difficult it is for you to come forward. i can say how much we appreciate your input so we could make the right decisions spending forward. with that, i would like to start. thank you for your comment to my colleague. one of the areas again as a nurse and ms. levine, associate myself with your statement because sometimes it's easier to give a blanket hey you don't

know which are talking about. anyone who knows bterfor your family as you. unfortunately that is one of the downfall of avner seen in some time we share our opinions to openly. i am concerned about the misconception of loss is because as we now, there's so many frivolous malpractice lawsuits at their and this is one of those gray areas where help your professionals do not feel protected and certainly hippa violations can be weighed against them but at the same time this very small part is, that is not necessarily an avenue that would be taken. am i correct with your testimony? >> search me there's nothing in hippa to the extent you seen any

lawsuits around privacy violation, they are filed under state law provisions. i don't do my part rare, but but if you're being -- if you face a lawsuit that's a statewide action. >> thank you. mr. wolfe, i'd like to rest a few questions here situation. i thank you for being brave and sharing that with us. i read over your testimony to find you're in a situation where you knew of us have made to your son. you knew there was a drug addiction and because of that behavior on his part with the manipulation that they do so well, he was able to manipulate

and kind of get his way. you were able to get him into the treatment facility, but then you are told they could not share information with you because of hippa. is that correct? >> the wind goes along with addiction from what i've learned from my son and others since this has happened is one quick example i wanted to go into a treatment program immediately. she said to me i don't want to go into an inpatient treatment because i don't want to start using up five for crack. i had to make the decision. i hear people do; and heroin and there's other users, which is what he indicated he was doing for not letting us know he was doing the heroin.

the lies and manipulation something to an outpatient unit agreed to go to. when i try to confront account there for the first couple weeks has denied any access to records while he was there. >> unfortunately is a story we continue to hear. i do think there are some changes that need to be made. more clarification than anything so health care professionals, family members and patient can understand what can be shared and what cannot. dr. martini, i have 30 seconds left. very recently is that the partnership for children. i represent the second district of north carolina a lengthy discussion about mental illness in relation to children. i have a very good friend whose

son is autistic and starting to show signs of depression and mental illness. because of his autism that had been diagnosed. could you say a few words about that? >> the availability of services is a critical issue. we need to expand our work for us not just among psychiatrists but no health professionals. as i alluded to before, we need to work with physicians. we need to work with schools. there are ways to provide services locally that can be efficient and effective beyond tertiary center. >> thank you so much. i appreciate the chairman given me a few more. >> to recognize her five

minutes. >> thank you, mr. chairman. thank you for your note of reality. ms. mcgraw, we are concerned about privacy and you can respect a certain ambivalence we must have for that is exhibited by this. the way you said the hippa gosch at the britain i put exclamation mark, exclamation mark because it's written to avoid liability, not to inform people of their right to her. dr. martini, i asked mr. rodriquez if you had a patient still used for bipolar patients are compensated, which he felt the loss of i.e. to

speak that listen if the kos article have a psychotic break. he seemed to indicate that would be permissible. would you accept that the most psychiatrists are doing? >> if he did not want the information shared, most psychiatrists believe if the patient was not an imminent danger to solve for others, most believe they should not share that information. >> at the patient has a history of being noncompliant and having a bipolar episode in creating these terrible heartrending stories occurring, would that change the calculus would still be now, we cannot do it. >> when i talked to colleagues of mine about the situation if they do with the patient that is dangerous, they informed

families and significant others that they may be a violation of hippa because it's the best interest of the patient. >> it's interesting because you say they take the risk and that that is a perception in some of what we've heard it said should be kind of like wow, don't worry it's not a risk. that tells me ambiguity about people who are full-time professionals. >> i think that true. the problem is it's the idea of waiting to eliminate danger. for a period of time but fairly stable. not to be rude, but there's a pattern of episodes. isis level going down and it's going to happen again. it doesn't do anything terrible that but does live under her prayers and sell all his

possessions and ran down the street, whatever. >> if it appears stable and doing well but the medications and the disorders quite often are episodic, if there would be concerned if they told the family, but understand in many situations they need to do that because the patient has a history. >> there is a perception of running the risk? ms. mcgraw, mr. kelley, i think while familiar if we have a teenager. a year of no insight. he had no end date. you're not quite sure how to address that. >> as smart as you are and you're an expert in privacy

committee learned something from mr. rodriquez testimony. seeking 20 patients in a does not in yor specialty, there's no way way the er physician can actually be as sci-fi with this information. what suggestions do you have? >> one of the things that that conversation about when i said i learned something director rodriguez is how incapacity place in the capabilities to share information members which is not imminent risk the circumstances under which mental health recessional can make a judgment about talking to a family member, which is in circumstances or in capacity. looking through the guidance right in front of me is the

issue of incapacity which is in fact in every good tree language. it does leave a lot of insurgency on the part of providers that have a complying with the site needs it would be helpful to have the kind of explorer that detail in my opinion. >> thank you again, mr. scalise. >> thank you, mr. chairman. thank you are having a hearing on a special to think the salmon numbers have been impacted by mental illness for coming and sharing stories with us. we had a real helpful forum back march the third at another family members including my district whose son matthew took his life and was being treated for mental illness are making

progress. pat and his wife debbie were trying to get information from the doctor, for the treatment centers that were not able to get the information in hippa was thrown up as the reason they couldn't get access. unfortunately, in this file he authorized his parent to have access to information. it was an incredibly frustrating, anchoring first hearing this and especially for parents trying to get the right kind of help for their kid and just couldn't get that access. so when we hear these stories by night he talked about them that people hiding behind, how do we get clarity to remove this gray

area if it is even in fact gray staffing vital information in cases where patients on access and it's been denied. if we can figure out what is this disconnect stopping this information being shared from the law doesn't preclude information from being shared. >> the thing that's missing in the situation is a discussion of looking at these cases on a much more individual basis and providing flexibility for rigorous appeal, involvement aye nations so there is an opportunity for psychologists and psychologists to present the case, to make her request for

modifications in this particular situations. sending how making it feel as though it's not the government telling people what to do but giving people an opportunity to protect rights, but also to ensure patients get the best care possible. >> i think we need to stare at medical education, nursing education and now education to have people presenting the rules of what is permissible and so for, not the risk managers. i'm sorry if anyone here is a risk manager. i think this perception that

those legal liability if anybody can sue anybody for anything. the real risk is in thse of electronic data and that seems to have been at our. >> i apologize. atomic on a minute left. >> think about the patient's best interest. >> i just want to say i feel it's important for parents to be apprised of what is happening with their children, even when they are legally emancipated and that is important because of the above i care since we do take care until the age of 26 i would not have lost just enough i was made aware of what he was going in for. for the best caregivers with

regard and there has to be an exception with regard to that. >> thanks. mr. kelley. >> i like to ask the committee and beyond. because founders of the families in these holes. quite frankly, change is hard and i want to thank ms. mcgraw because it's taken so long to hear what she just said. we need to change things and sometimes there's got to be a carve out for the severely mental unless the patient accepts clause rule the world. >> i think we need to be more aware of what hippa does prohibit and i think there should be some special clauses they are for the mentally ill. >> thank you. ms. transcendent. >> clear understandable disseminator places people can

find it. >> thank you, mr. chairman. i have backed the remainder of my time. i understand the ranking member has unanimous can that request. this committee has a practice of only accepting sworn testimony. will be asked to accept a letter which states for the hearing. we only became aware of this would not have time to review this statement. in this case, it is not a letter, but as i said before statement for the record which is not about sworn testimony. this is a point of personal privilege or the chairman one of the groups has repeatedly circulated false statements about the chairman and ranking

member and have repeated the purpose he misrepresented the work on behalf of patients, families and health care providers and the public. they've repeatedly and deliberately misrepresented, best in this case it a statement that his foreign testimonies that can enter the chair. >> i would ask unanimous consent to place a letter dated april 25, 2013 about the position of organizations regarding hippa by the self-efficacy network that they find time for mental health. i ask unanimous consent to put this in the record is the opinion of organizations. as we've discussed before, i've been on the set committee for 16 years, mr. chairman dennis from the pack is to take testimony

and your absolutely correct this is not under a. it is also bad practice that the committee to get extensive information that might have expertise or opinions that otherwise. simply accepting a document does not necessarily imply agreement with physicians in that document by either the chair, ranking member or rather to give a more full picture what people think. i do not consider this april 25th letter to the testimony for a substitute for testimony. it is a statement of the growth and i've got many examples i could give, but in the interest of the time i simply asked them look forward to working with you to clarify documents will be put in the future. i would also note we did a an

article from "sports illustrated" in the record today. seems to me that it would be appropriate. >> i understand the unique circumstances in this case. we will accept us into the at this time and maturity will put a statement along with it.